<div class="container">
  <form class="form-horizontal" role="form" method="POST" action="<?php print URL . 'home/checkout';?>">
    <fieldset>
      <legend>Payment</legend>
      <?php 
      if($results == 1) {
      ?>
      <span style="font-size:18px; font-weight:bold; color:green">Payment Processed Successfully<br></span>
      <?php 
      	exit;
      } elseif($results == -1) {
      ?>
      <span style="font-size:18px; font-weight:bold; color:red">Error : Credit Card is not Valid<br></span>
      <?php 
      }
      ?>
      <div class="form-group">
        <label class="col-sm-3 control-label" for="card-holder-name">Amount &nbsp;</label>
        <div class="col-sm-9">
          <input type="text" class="form-control" name="totalAmount" id="totalAmount" value="<?php print $amount;?>" readonly>
        </div>
      </div>
      <br>
      <div class="form-group">
        <label class="col-sm-3 control-label" for="card-holder-name">Name on Card &nbsp;</label>
        <div class="col-sm-9">
          <input type="text" class="form-control" name="card-holder-name" id="card-holder-name" placeholder="Card Holder's Name">
        </div>
      </div>
      <br>
      <div class="form-group">
        <label class="col-sm-3 control-label" for="card-number">Card Number &nbsp;</label>
        <div class="col-sm-9">
          <input type="text" class="form-control" name="card-number" id="card-number" placeholder="Debit/Credit Card Number">
        </div>
      </div>
      <br>
      <div class="form-group">
        <label class="col-sm-3 control-label" for="expiry-month">Expiration Date &nbsp;</label>
        <div class="col-sm-9">
          <div class="row">
            
              <select class="form-control col-sm-2" name="expiry-month" id="expiry-month" style="width:100px;">
                <option>Month</option>
                <option value="01">Jan (01)</option>
                <option value="02">Feb (02)</option>
                <option value="03">Mar (03)</option>
                <option value="04">Apr (04)</option>
                <option value="05">May (05)</option>
                <option value="06">June (06)</option>
                <option value="07">July (07)</option>
                <option value="08">Aug (08)</option>
                <option value="09">Sep (09)</option>
                <option value="10">Oct (10)</option>
                <option value="11">Nov (11)</option>
                <option value="12">Dec (12)</option>
              </select>
             &nbsp;&nbsp;&nbsp;
              <select class="form-control" name="expiry-year" style="width:100px;">
                <option value="13">2013</option>
                <option value="14">2014</option>
                <option value="15">2015</option>
                <option value="16">2016</option>
                <option value="17">2017</option>
                <option value="18">2018</option>
                <option value="19">2019</option>
                <option value="20">2020</option>
                <option value="21">2021</option>
                <option value="22">2022</option>
                <option value="23">2023</option>
              </select>
            
          </div>
        </div>
      </div>
      <br>
      <div class="form-group">
        <label class="col-sm-3 control-label" for="cvv">Card CVV &nbsp;</label>
        <div class="col-sm-3">
          <input type="text" class="form-control" name="cvv" id="cvv" placeholder="Security Code">
        </div>
      </div>
      <br>
      <div class="form-group" align="center">
        <div class="col-sm-offset-3 col-sm-9">
          <button type="submit"  name="submit_payment" value="1" class="btn btn-success" style="width:200px">Pay Now</button>
        </div>
      </div>
    </fieldset>
  </form>
</div>